The objectives of this Program Project are to improve patient outcomes in Rheumatoid Arthritis (RA) by identifying and documenting more optimal treatment strategies, encouraging use of more effective medications, reducing drug toxicity, and making patient education programs widely available over the internet, and thus providing effective self-management treatment adjuncts. This program introduces systematic use of cumulative outcome measures, broad use of therapeutic segment concepts, identification of optimal drug sequences protein micro-array searchers for causal agents in RA inception cohorts, and internet approaches to patient education, outcome assessment, and clinical decision making. The Program builds upon the large high quality multi- disciplinary data sets of ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) built over the past 25 years, together with established collaborations, methodological and technical resources, quality control methods and outcome assessment capabilities. ARAMIS 2006 will take this Program into its 30th year of productive service. We will study in aggregate approximately 10,000 patients with over 45,000 patient years of follow up. Two Cores and four inter-related Projects are proposed. Core A provides methodologic support, including a scanning interface for outcome assessment, and Core B provides RA inception cohorts of over 1,500 patients enrolled in their first year of disease for study. Project 1 identifies optimal RA treatment sequences using decision-analysis techniques and compares effectiveness, toxicity, and costs of alternative treatments for RA. Project 2 creates and evaluates patient education programs provided over the internet. Project quantitates the neglected effects of arthritis and its treatments on the incidence of heart disease stroke, colon cancer, and lymphoma. Project 4 studies long term outcomes of RA in minority populations and examines the reasons for disparity in outcomes. In sum, this Program Project has the potential for substantially improving treatment and long term outcomes in millions of patients with RA and OA.